Date of Graduation

Spring 5-1-2024

Document Type


Degree Name

Doctor of Psychology in Clinical Psychology (PsyD)


School of Nursing and Health Professions




Clinical Psychology (PsyD)

First Advisor

Dr. David Martinez

Second Advisor

Dr. Catherine Benedict

Third Advisor

Dr. Cori Bussolari

Fourth Advisor



Family building and fertility is a complex component of survivorship for assigned female at birth Adolescent and Young Adult’s (AYA-F’s), often accompanied by a mix of cognitive uncertainty, emotional uncertainty, reproductive distress, and avoidance. These psychological components present in survivorship for AYA-F’s can impact coping, identity development, and individualized care plans throughout survivorship. This novel examination of data from a cross sectional study shed light on the associations between reproductive distress, uncertainty, and avoidance and how they are experienced differently by various subgroups within the sample.

Results demonstrate that reproductive distress fully mediated the association between emotional uncertainty and avoidance, while no association was demonstrated between cognitive uncertainty either directly or indirectly through reproductive distress. When controlling for age, age at diagnosis, education level, household income, and decisional self-efficacy, the mediation between emotional uncertainty and avoidance through reproductive distress was no longer observed (although emotional uncertainty and reproductive distress were still associated) and no other significant associations were found amongst the main psychological variables of interest. However, there were significant findings between age at diagnosis, household income and self-efficacy with reproductive distress as well as between self-efficacy and avoidance.

These results implicating decisional self-efficacy with avoidance adds to existing literature on avoidant behavior predictors for AYA-F’s specifically. By better understanding these associations, survivorship experiences and individualized fertility related support needs are now better understood and the standard of care for AYA-F’s in survivorship can be better tailored to the nuanced psychosocial needs identified within this study.